MEDICARE: DR. STEPHEN ANDREW HENDERSON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR008111	GA

General Provider Information

NPI Number	:	1356428155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ANDREW HENDERSON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 219
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-0219
Country	:	US
Telephone Number	:	678-943-1086
Fax Number	:	678-943-1086

Provider Business Practice Location Address
First Line	:	5449 THOMPSON BRIDGE RD
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-1948
Country	:	US
Telephone Number	:	678-943-1086
Fax Number	:	678-943-1086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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